(精编)【持续性肾脏替代治疗CRRT英文精品课件】 CRRT(65p).pptVIP

Sliding Scale for Volume Adjustment Desired volume change (ml/hr) PAWP 6 PAWP 6-8 PAWP 9-11 PAWP 12-14 PAWP 15-17 PAWP 18-20 PAWP 21-22 PAWP 22 + 175 ml and notify nephrologist + 125 ml + 75 ml Zero balance ? 50 ml ? 75 ml ? 100 ml ? 125 ml and notify nephrologist Clinical Aspects Electrolyte and Acid Base Derangements Continuous therapies can be used to correct water and electrolyte imbalances Hypo-hypernatremia can be corrected not only achieving a normal plasma sodium concentration, but also by restoring the normal body sodium content Hyperkalemia can also be corrected: the efficiency of continuous arteriovenous and venovenous hemofiltration in removing potassium is low AKI in Neonates Continuous arteriovenous hemofiltration is especially useful in the treatment of acute renal failure in neonates and small babies (Ronco et al. 1984, 1986) CRRT as a successful bridge to liver transplantation should be considered in children with unrelenting hyperammonemia not amenable to routine medical therapy (Chen CY et al. 2000) Treatment of Multiple Organ Dysfunction and Sepsis with CRRT Eicosanoids, cytokines (tumor necrosis factor and interleukins such as IL-1, IL-6, and IL-8), endothelin, and platelet-activating factor may all contribute to the reduction of renal blood flow and GFR during sepsis ARF cannot be treated effectively unless the underlying problems are resolved CVVH using the high-permeability membranes allows extraction of significant quantities of circulating macromolecules (MW 30 kDa) CRRT of AKI in Burns Patients CRRT may maintain a good uremic control for severely catabolic burns patients with multiorgan dysfunction Treatment is possible despite cardiovascular instability and total parenteral nutrition can be given CAVHD appears to give somewhat better uremic control, but the difference in mortality is not significant Large burns, pulmonary burns and septicemia seems to be bad prognostic signs (Leblanc et al. 1999) Advantage of CRRT for Nu